It may not spread rumors about you or leave mean comments on your Instagram, but make no mistake — chronic zits are a huge bully on your self-esteem. Extreme cases have been linked to anxiety — even suicide. And these serious side effects may be more common than you think: A major study published in The Journal of the American Academy of Dermatology says waking up to severe breakouts daily may make you two to three times more likely to develop depression. The study says: "Girls and boys with acne had significantly more depressive symptoms, lower self-attitude, more feelings of uselessness, fewer feelings of pride, lower self-worth, and lower body satisfaction than those without acne."

Worse, another report from the British Skin Foundation found that one in five people struggling with acne has considered suicide. Reason number one? It makes you feel alone. "Skin disorders tend to isolate," says Clinical psychotherapist Matt Traube. Suddenly, you're skipping hangouts with the girls or dodging eye contact and conversations. "When you already feel hopeless and embarrassed, that can only intensify those feelings," he says. Throw in the fact that hormones are already sending you on a constant emotional roller coaster, and it's no wonder acne is seriously stressing you out, says psychologist Jennifer Gentile, Psy.D, M.M.H.S.

But don't give up hope. Nothing is permanent — no matter how much you think it is, says Traube. Ask a derm about your options. And when the anxiety starts to feel like too much, talk to a therapist. Know that you are not alone. (In fact, about 20 percent of teens are just as bummed as you, according to the National Alliance on Mental Illness.) And remember: Acne is treatable. Says dermatologist Dennis Gross, M.D., "Once your skin starts to clear, you can feel like you have your life back." Gabrielle, 20, from New York, NY, agrees. "I'm not a shy person at all, but acne made me so quiet. Since I started taking medication, literally everything has changed for the better."

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Acne dysmorphia — it's a thing. Your friends say your skin looks amaze... but you don't see it in the mirror. The difference may be in your head. Since you constantly see "perfect" (aka filtered!) skin on social media, it's easy to perceive a tiny imperfection as a big deal. "We see people who've treated their acne and have mild scarring, but they think it's severe," says derm Eric Schweiger, M.D. Visit a counselor or therapist if you can't seem to shake the skin-securities.

If acne is messing with your self-esteem, don't wait to seek help. Talk with a pro, like a school psychologist or your doctor. It's their job to be judgement-free and make you feel comfortable telling them anything you want. "You can lessen the severity of your depression symptoms if they are addressed early on," says Dr. Gentile.

Need to talk to someone right now? You can call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or contact the Crisis Call Center by texting ANSWER to 839863.

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A version of this story was originally published in the December/January 2017 issue of Seventeen. Pick up the issue in stores everywhere now or subscribe to get instant access.

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